ABCL-059 Congestive Heart Failure, an Early Unusual Complication of Anthracycline Based Chemotherapy.

Anthracyclines are among the chemotherapeutic agents implicated in cardiotoxicity. They are associated with an increased risk of developing heart failure with significant comorbidity and mortality. However, they remain important components of many curative chemotherapy regimens. Risk of cardiac toxicity occurs usually after cumulative dose and is rarely reported after one single exposure. We report the case of 72 years-old female patient, previously healthy, diagnosed with stage II diffuse large B cell lymphoma CD20-positive. After geriatric assessment, she was clear for chemotherapy. An initial cardiac ultrasound was within normal limits: ejection fraction of 60%. In the same perspective, serum troponin was also normal. She was started on a standard treatment with mini-RCHOP (rituximab, cyclophosphamide, oncovorin, doxorubicin, prednisone) protocol. Ten days after the first session, she suffered from a worsening dyspnea, with new onset orthopnea and presented to the emergency department with respiratory failure. Investigations revealed pulmonary edema. There were no ischemic changes on the electrocardiogram. Serial serum troponin levels were within normal, but pro-BNP was > 7500 pg/mL (normal value < 100). Repeated cardiac ultrasound showed a drop in ejection fraction to 35%. Cardiac catheterization was performed and there no ischemic heart disease. Cardiac MRI ruled out any infiltrative heart disease. Respiratory viral PCRs and viral serologies were performed to exclude any viral myocarditis. Consequently, she was diagnosed with anthracycline-induced cardiomyopathy and was started on intravenous diuretics, oral β-blockers, ACE inhibitor and spironolactone. Her dyspnea improved and was discharged one week later. She continued her treatment with mini-RCOP (without doxorubicin) and she went into complete remission after 6 cycles. By the end of the treatment, the cardiac ultrasound revealed an improvement in ejection fraction reaching 50%. Anthracycline-induced cardiomyopathy is a serious life-threatening complication. It is usually unpredictable and often occurs with cumulative dose exposure of anthracyclines. Cardiovascular risk factors prior to anthracycline exposure can increase its risk. Clinicians must be aware of the early onset of cardiac injury. Baseline cardiac evaluation, as well as clinical cardiovascular risk assessment, are mandatory.